Confusion Over Sexuality in the Nursing Home

Every facility at one point or another will have to come to terms with the expression of sexuality by their residents.  This creates a ton of confusion with the staff, administration, corporate, families, ombudsman, and surveyors. To tell you the truth, it can be very confusing if you’ve never had to deal with it before or had no one to teach you.  That was the case for me, as well.  So, after having dealt with a few of these situations, I can now offer you some guidance so you don’t pull your hair out wondering if you did the right thing.

At one particularly confused facility, I had two residents who had developed a fondness for each other and seemed to want alone time together.  At least that’s what the male resident who could make his own decisions said, even though his family was mortified at Dad doing that kind of thing.  His chosen mate, unfortunately, could not make decisions very well and was frequently confused.  When I inherited this facility, I found out the staff had been allowing the residents to have sex per the direction of the Ombudsman (who was watching out for those residents’ rights! 🙄 ) and the confused female resident’s daughter who stated, “My Momma can have sex if she wants to…”

Hit the brakes!  Oh, no she can’t!  Not in my building if she can’t give consent.  Finding out this little bit of information gave me a headache and a few heart palpitations.  Let’s go through a couple of points to consider here.

  1. The major determining factor of whether to allow these two residents to have sexual interaction lies with the ability of both residents to give consent.
  2. It doesn’t matter whether the confused female’s daughter has a POA, guardianship, conservatorship, or anything else.  The resident is in the care of the nursing home.  True – when a resident is unable to make their own decisions, the resident’s rights are transferred to the Responsible Party or to an individual directed by a court.  However, this does not include the ability to violate their human rights.  Human rights remain with the resident.  A responsible party cannot direct for a resident to have sexual intercourse or be subjected to any form of such interaction any more than they can direct for the resident to receive a high dose of insulin when the resident is not even diabetic.
  3. An Ombudsman has no authority to direct anything in this situation.  (This was a particularly bad Ombudsman).  However, if the Ombudsman feels like the resident’s rights are being violated, they must report this to the State.  So, you need a protocol in place to shut down any potential deficiencies.

First and foremost, you should have some type of sexuality assessment tool in place to determine the resident’s ability to give consent.  Here is a generic one (click here) that borrows a bit from Lichtenberg & Strzepek, 1990, Lichtenberg, 1997, and an old Pro-Ed form I got from a colleague in 2001.  Feel free to modify and individualize it for your own facility.

As you can see, there are many points to consider in order to make a determination of the ability to give consent. Use an assessment.  Review the results with the IDT team, family, and physician.  There may need to be some ongoing education and reminders for the resident to ensure their continued understanding and safety.  Or, they simply may not pass at all.  Update the care plan with the sexuality assessment and ongoing plan.

I had a female resident at one facility whose former profession was prostitution.  She was moderately confused at times, but still had enough about her to select a male suitor to fancy.  The problem, other than her unpredictable state of mind, was that she had syphilis.  And, the particular resident she selected to be her fellow had HIV.  What a bad combination.  Of course, neither knew about the other’s condition and I couldn’t tell them due to HIPAA.  So, I had to develop a sexuality assessment for the facility which included risk of STDs.  He passed fine.  She didn’t.  I then had a long talk with both residents individually.  In my conversation with the male resident, I might have thrown in a few hypothetical situations that would help persuade a man not to pursue a woman. 🙂   Right or wrong, it worked.  He stayed his distance from her and we didn’t have any problems.

Stay tuned for Part 2 where we’ll discuss behavior management for aggressive hypersexual residents when there is no consent for sexual interaction.

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2 Responses to “Confusion Over Sexuality in the Nursing Home”

  • williamv on

    I really enjoy your posts! I am an RN in my AIT and this is fantastic info! Thanks for all your work.

  • Mark on

    No problem, williamv. Thanks for stopping by!


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